Restarting oral anticoagulant therapy after major bleeding in atrial fibrillation: A systematic review and meta-analysis.
Int J Cardiol
; 261: 84-91, 2018 06 15.
Article
en En
| MEDLINE
| ID: mdl-29572080
ABSTRACT
BACKGROUND:
Use of oral anticoagulant (OAC) therapy in atrial fibrillation (AF) is associated with an inherited risk of bleeding. Benefits and risks of OAC restarting after a major bleeding are still uncertain. We aimed to assess effectiveness and safety of restarting OAC in AF patients after a major bleeding event.METHODS:
We performed a systematic review and meta-analysis of all studies reporting data about AF patients that sustained a major bleeding, reporting data on restarting or not restarting OAC therapy.RESULTS:
A total of seven studies were included, involving 5685 patients. No significant difference was found in "any stroke" occurrence between OAC restarters and non-restarters (odds ratio [OR] 0.75, 95% confidence interval [CI] 0.37-1.51), with a significant 46% relative risk reduction (RRR) (pâ¯<â¯0.00001) for "any thromboembolism" in OAC restarters, with consistent results when the index bleeding event was an intracranial or gastrointestinal bleeding. A significantly higher risk of recurrent major bleeding was seen (OR 1.85, 95% CI 1.48-2.30), but no difference in risk for recurrence of index event. OAC restarters had a 10.8% absolute risk reduction for all-cause death (OR 0.38, 95% CI 0.24-0.60); pâ¯<â¯0.00001). Net clinical benefit (NCB) analysis demonstrated that restarting OAC therapy after a major bleeding was significantly associated with a clinical advantage (NCB 0.11, 95% CI 0.09-0.14; pâ¯<â¯0.001).CONCLUSIONS:
Restarting OAC therapy after a major bleeding event in AF was associated with a positive clinical benefit when compared to non-restarting OAC, with a significant reduction in any thromboembolism and all-cause mortality.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Contexto en salud:
6_ODS3_enfermedades_notrasmisibles
Problema de salud:
6_cardiovascular_diseases
Asunto principal:
Fibrilación Atrial
/
Hemorragia
/
Anticoagulantes
Tipo de estudio:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Risk_factors_studies
/
Systematic_reviews
Límite:
Humans
Idioma:
En
Revista:
Int J Cardiol
Año:
2018
Tipo del documento:
Article
País de afiliación:
Italia